 Can I ask everyone to take a seat, please? Thank you. I know we have a lot of folks roaming around, but I want to get started because we have a very packed day. My name is Rebecca Katz. I'm an associate professor here at the Milken Institute School of Public Health at George Washington University. And delighted to have everybody here. I want to first introduce my dean, so who will provide some opening remarks. Lynn Goldman is the Michael and Laurie Milken Dean of Public Health at the Milken Institute School of Public Health at the George Washington University. Dean Goldman is a member and serves as the governor and counsel of the Institute of Medicine. And before joining George Washington, she was a professor of environmental health sciences at Johns Hopkins University and an assistant administrator for toxic substances at the US Environmental Protection Agency. And even for that, she was with the California State Health Department. So I'm delighted to introduce Dean Goldman. Good morning. I'm wondering if I'm the test subject for the AV system. Can everybody here? Yes, thank you. Good morning and welcome to everybody to the Milken Institute School of Public Health at the George Washington University. We are so pleased to be able to host such an important event in our new LEED certified platinum building. For those of you who aren't aware, we will be live webcasting this event. On behalf of the consortium of organizations who put together this event, the George Washington University, the Nuclear Threat Initiative, Cords, Connecting Organizations for Regional Disease Surveillance, the University of Pittsburgh Medical Center for Health Security, American Association for the Advancement of Science, the Center for Strategic and International Studies, and the Elizabeth Argriff and Research Foundation, I am pleased that you are joining us for this important opportunity to discuss the Global Health Security Agenda. The Global Health Security Agenda is a new initiative launched February 13th of this year and is already a 40 plus nation effort. It also involves the Directors General of the World Health Organization, the Food and Agriculture Organization, and the World Organization for Animal Health as well as representatives from the European Union. The goal of the Global Health Security Agenda is to strengthen global capability to prevent, detect, and respond to infectious disease outbreaks. Building these capabilities around the world will reduce morbidity and mortality, strengthen economic development, and contribute to the goals of the international health regulations and other international undertakings. We hope that convening this significant gathering today will raise awareness of the Global Health Security Agenda, spark discussion of proposed priorities for the next five years, and provide governments with ideas for future commitments and actions. Throughout the day, you will hear from experts discussing the ongoing Ebola outbreak, which is currently overwhelming containment and treatment measures. Just two days ago, if you read the New York Times, the CDC issued chilling estimates, Ebola cases could reach as many as 1.4 million by January 20th. This is the worst-case scenario based on computer modeling. But if even close to true, it is clear that the medical infrastructure is entirely insufficient to handle this ongoing outbreak, we need to be taking action now so that we do not attain those worst-case projections. This also points out that the Ebola outbreak desperately requires global attention to not just respond, but to build long-term capabilities in the region so that future public health emergencies are mitigated with less loss of life. The Ebola outbreak underscores just how important it is to build global capacity to prevent, detect, and respond to infectious diseases. It also underscores the need for us to approach these daunting global threats, whether Ebola, antibiotic-resistant bacteria, or flu, was what I would call realistic optimism. What do I mean by that? I mean optimism that is not based on or deleting ourselves or others about the seriousness of these threats, but rather that we can be optimistic because of the fact that we have the resources, we have the know-how, we have the collective will to address these threats if we can only come together, work together to address them. As the dean of a public health school where our mission is focused on prevention, especially when it comes to the world's most vulnerable populations, I sincerely hope today's presentations and discussions will go a long way to developing thoughtful intervention strategies and realistic solutions to prevent infectious disease outbreaks. Thank you all for being here today. Dr. Ketz, let's come back up. All right, before we get started, I just wanted to go over some basic logistics and housekeeping. We are thrilled by the great interest in this event and has however made this room a little bit crowded and it might get more crowded as we go on through the day. Just so folks are aware, we have arranged an overflow room where the event will be webcast if for any reason you wanna spread out a little bit more. So that'll be on the third floor and we can direct you there. Additionally, as the dean mentioned, this event is being webcast. The webcast site is located in, there's a tech info page in the Blue Milken Institute School of Public Health folders. There are bathrooms on every floor, including them, they're right outside this room and they're in the same location on all seven floors. The internet access code is also at the registration desk and also on that tech info page in the Blue folders. There will be, sorry, push something. The food for the coffee breaks will be on the second floor, lunch will be on the second and third floor as well as the coffee break in the afternoon will be on the second and third floor. The posters will be on the second floor and booths on the third and we invite you to visit them particularly during the designated session during the afternoon. There is a map of the building at the registration desk and we also have people available to direct you wherever you would like to go. So please just let us know. And also if you need a quiet space for phone calls or side meetings, also let us know and we've reserved some rooms for that as well. I just want to reiterate how thrilled we are that you all could join us today for this important meeting on the Global Health Security Agenda. And again, to not just thank the organizing steering committee but also the UN Foundation, CRDF Global Skoll Foundation and Foundation Meru who graciously have supported this event today. I'd now like to invite Dr. Steven Morrison from CSIS who will immoderate discussion with Dr. Keji Fukuda from the World Health Organization and Laura Holgate from the National Security Staff at the White House. So please. Thank you everyone. I'm Steve Morrison from CSIS. We're very proud to be one of the partners in organizing this and I want to congratulate those who really put in quite a bit of effort in pulling things together today particularly Becky Katz, Julie Fisher, Talia Dubovie from CSIS, Deb Rosenblum, Kavita Berger, Tom Inglesby and many others. I also want to thank Beth Cameron from the White House staff who has been indefatigable over many, many months in moving forward the Global Health Security Agenda and as a close friend and ally. Last night, we had the occasion to pull together a number of folks from the Hill, 16 or 17 senior Hill staff, Republican Democrat, House Senate, Appropriators, Authorizers, leadership personnel, it was very interesting. They were in an interaction with Tom Frieden with folks from the joint staff, from the White House, from USAID and other agencies involved in this massive mobilization around Ebola in West Africa. One of the themes that came through very powerfully in that quite constructive and forward-looking discussion was we need to think long-term. And I think that when we were party back in February, when the White House launched the Global Health Security Agenda, we worked collaboratively with the same partners that are here today on the NGO side to have a launch at CSIS, Laura Holgate, the Senior White House Director for WMD Terrorism and Threat Reduction came over along with Tom Frieden and others and presented. It was a, the launch was on a snowy day on February 13th. The official gathering at the White House, despite the blizzard and a week later we had a rollout event that brought together several hundred people to talk about the importance, the significance and the future of all of this. We didn't know at that time that we would be facing a threat of the kind that we face today with Ebola, but it seems to me looking back that this was a very prescient and timely initiative and one that lays the groundwork in institutional terms and international terms, on diplomatic terms, the vision for why this is so important on health security. And we'll hear more from Laura in a moment on that. So the sentiment last night was think long-term, think multi-year, think about our partnerships. Think about how the US leadership is to be articulated in partnership with WHO with other partner governments themselves with the non-governmental sector. And this gathering here today is really about the non-governmental sector defined quite broadly, scientists, researchers, implementers, those in universities and foundations, research institutes and associations, really where is the fit? What is your contribution? What are the special assets that you bring to the fight here in building long-term over health security? We're very honored today that we have such notable leadership here with us. Laura Holgate, as I said, as a senior director at the White House, MMD, WMD terrorism and threat reduction prior to that served for eight years in the nuclear threat initiative as the vice president there. Prior to that served in very important positions at DOD and at the Department of Energy on threat reduction proliferation issues there. Thank you, Laura, for being with us. KG Fukuda also on the WHO side, a very prominent and notable personality, a leader, someone that we've seen and known for a long time. Both Laura and KG have substantial continuity of leadership in their roles. Laura's been there since 09, KG has been the senior, has been the assistant director general at the World Health Organization, responsible for health security and environment for those four years. On pandemic flues, he has been full-time on that since 1996, as I understand, in various guises. He's a career physician, he's an American, he started his career at CDC, where he was the head of the epidemiological unit at the Influenza Branch and migrated over to WHO in the mid-naught decade where he's played a critical role in the swine flu outbreak among other questions of preparedness. So we're really thrilled to have you both here, Laura, and KG, what we'll do is we'll roll through some opening remarks from each of them, in which we've asked them to think about what is the global health security agenda, why are they both here to talk to us about this? What does it mean? And of course, Ebola has to figure in all of these discussions, so we'll hear something about that. We'll come back for a conversation. We have only until 9 a.m., so time is short. Laura, the floor is yours. Well, thanks so much, Steven, to the whole team here, all of the NGO affiliates that have supported this event this morning and of course to the GW team for making it such a beautiful and well-organized as well as contentful session. It's a special joy to see some of my NTI colleagues from the time I was there and especially some I haven't had a chance to see in a while. So I also have to say a very special thanks to Beth Cameron, who has really been the stalwart force behind this. I've been blessed with some amazing people, including best predecessors and bringing forward what I have always been convinced is a hallmark initiative for this administration and a gender setting concept on how do we manage bio threats of any form and to be able to have put some of that together in the president's very first substantive presidential directive and then find ourselves here five years later with such a robust content, such broad support internationally in international organizations with partners all around the world is really, it's astonishing to think how far we've come in the last few years and particularly since February when we launched this agenda fully born in its detail and content. On behalf of the White House, I do give a special thanks to the NGO working group, the Indio Steering Group and other organizations and we appreciate the consultations that we were able to do with you prior to our February launch and then to come back so quickly after that launch and CSIS to share the vision to invite your participation and improvement to what we're proceeding forward with. Your input has been invaluable in shaping the direction of this ambitious and critically important effort and it truly requires a whole of society approach. As you know, the Ebola epidemic is severe and getting worse. You've heard the estimates of what the disease curve may look like over the next few months but we know that core public health interventions and the commitment to build back essential health infrastructure can stop it. Success, not only in stopping the Ebola epidemic but also for minimizing future outbreaks requires speed and scale and deploying effective prevention and control measures and committing the necessary resources and political will to make long-term commitments to the systems that are not yet in place or not sufficiently in place throughout the world. If the capacity that we seek to urgently accelerate through the global health security agenda had been in place, it is likely that the Ebola crisis would not be as severe but the reality is that Ebola has already killed four times the number of people that SARS did over a decade ago. Such a dramatic threat requires a long-term commitment as well as an urgent immediate response. This is not a choice we make between these two styles. We must be doing them at the same time together and mindful of each other. The purpose of the agenda is to elevate global health security as a national priority around the world, to energize and empower partners, to focus on specific objectives where collective action can be taken to achieve measurable results. The Ebola crisis shows us the very real and immediate need for such an agenda and the imperative of increased commitment to specific measurable actions. We are seeing some signs of progress. International assistance is coming in, but more is needed. Last week, President Obama announced a major increase in the US response and today in New York, nations are coming together to highlight and fill specific and urgent needs and the leaders from the affected countries are committed to action and eager for assistance. But the gap is enormous. We've identified some key challenges including a need to improve the global ability to work across sectors, to leverage capacity and resources, to develop the international systems that are required to prevent, detect, and rapidly and effectively respond. This is the alignment of effort across sectors within and without government. So if we think about any Ebola that we're working to bend the curve, those incredibly scary curves that we see of predicted disease, with the global health security agenda, we're looking to get ahead of the curve and that's really the way we see these pieces fitting together. The work of the non-government sector is conducting from program implementation on surveillance and monitoring is vital to government's abilities to make progress against the specific commitments that we're making under the GHSA. You will hear more about the action package process, also known as lines of effort that support the global health security goals and we want to hear from you about how we can improve our framework and learn more about work that you're doing that will help us accelerate these goals and importantly, to measure our collective progress. And we'll be sharing with you these action packages on an embargoed basis today for you to have a chance to engage with them during today's discussion. We'll ask that you respect our attempt to make some news tomorrow with our ministerial. We do hope that by the end of today, many more of you will be able to go back to your organization with a more well-defined sense of the global health security agenda and areas of alignment between what governments around the world are doing to accomplish these goals and how non-government organizations can engage most effectively. We're honored looking to tomorrow that President Obama will speak in support of the global health security agenda and you will be joined by National Security Advisor Ambassador Susan Rice, Assistant to the President for Homeland Security and Counterterrorism, Lisa Monaco, Secretary of Health of Human Services, Sylvia Burwell, Secretary of State John Kerry and Secretary of Defense Chuck Hagel. You could not ask for a more cross-sectoral team than that and we are certainly hopeful that that level of commitment and breadth of commitment is reflected in the participation and comments of those other countries who are participating. This underscores the critical nature of the multi-sector response to make the most effective use of resources and activities nationally, globally and internationally as we work to improve global health security capacity. Tomorrow, 44 governments in leadership from the WHO, the Food and Agriculture Organization of the United Nations and the World Organization for Animal Health and the World Bank, as well as senior officials from the African Union, European Commission, Interpol and the United Nations will come together to develop new commitments to build the system to prevent, detect and rapidly respond to biological threats whether naturally occurring, deliberate or accidental. And I want to thank you again for your leadership and for hosting this meeting. The need is urgent. The gap is enormous. The consequences of inaction are simply unacceptable. I challenge you to think how you can work across your own sectors and within government and non-government groups to achieve our goal of a world safe and secure from infectious disease threats where what is occurring in West Africa right now can never happen again. Thank you so much and I look forward to the discussion of the day. Thank you, thank you Laura. Keiji, floor is yours. Thanks Steve and thanks Laura for those very wise words. I also want to start out simply by thanking everybody for coming here this early in the morning and thank Dean Goldman and Rebecca for the invitation and Steve for organizing. And like everybody else, I want to embarrass a couple people here. So, you know, there's been a huge number of people working on health security over years and then on working on the health security agenda to pull it together and I'm not going to try to name people in this process but I want to point out the leadership role of both the White House, HHS, a number of organizations working with member states across the globe. But I think as all of you know at the heart of any complex and difficult activity there's always a core of people and then at the core of that group of people there's really someone who's usually in the middle and that person's wearing a green jacket over there and as everyone has singled out Beth for a special embarrassment, she slept an hour last night which I think is more an hour more than she normally sleeps. So, you know, you can see where all of this lies. But let me cover a couple of points here. The first thing I just want to say why is WHO even here? What do we participate again? This is one of the questions which came up over and over again in the beginning and the answer to that is pretty simple and pretty clear. For WHO and at the global level, the development of global health security taking that forward is one of the critical priorities for the organization and one of the critical priorities that we see in terms of global health. And we see that this initiative here is a member state initiative to move beyond the level where we are right now. Right now we have things in place and we have to move beyond and I think that the Ebola outbreak highlights where we are vulnerable, what remains to be done. And I'll talk a little bit about that but it is no more complicated than that. It is simply something which we have to move ahead and do. It's going to depend on the actions both of countries but also below countries the contributions of non-governmental organizations pulling in communities and it depends on actions. This whole Ebola situation has brought up the need to move beyond just concepts and discussions and to actually implementing on certain actions and that's why we're here and that's why we're gonna be here with OIE and FAO and our other colleagues at the international level. Now in terms of what we are seeing right now it's inevitable that we have to discuss the Ebola situation because it is the outstanding example for why health security is so critical. Now there are a number of people here in the audience that have been working on this situation both in country and at the international level and I think there'll be some additional discussion but I've now visited the region I think about six times in the past three or four months and have seen it evolve both on the country level and then have had the privilege of sitting in on a number of discussions taking place at the international level. And based on that and based on what I have seen in the previous events such as SARS and avian influenza, pandemic influenza and so on it is clear that this is probably the most difficult global health security challenge that we have faced in our lifetime certainly related to infectious diseases and so why is that? I think there are probably four important things to highlight here. In the first place in terms of the disease we are working with something which is moving very quickly which is scaling up very quickly and which is simply highly lethal. We often deal with infectious diseases in which the numbers are much larger than we're dealing with right now but what makes this different is that with a lot of infectious diseases we don't have to stop transmission but with this disease we have to stop transmission. It is not good enough to say that we'll focus on the care of people. We have to stop transmission and that is what makes this so difficult in terms of a disease. The second factor is simply the setting. I think that you all know that this is a region which has gone through some quite difficult conflicts in the past. It has come out of that conflict and it has been one of the highlights in the African region and globally in terms of developing its economics and moving ahead in terms of its social frameworks and this whole Ebola situation however is occurring at a time when it is still developing and it is vulnerable and so I think that when you go there and you visit you see the impact of severe poverty there. You see the impact of health systems which are developing but which are simply still weak and weak enough, not strong enough to deal with the situation. It is also a setting in which you have countries coming across and bordering each other and in those bordering areas the administrative borders are not what people see so they go across these borders and so you have a kind of mixing of people and all of this is contributing to the current situation. The third factor that I wanna highlight is the impact. A lot of times when we're dealing with infectious diseases there is concerns at various levels but in terms of this one you see the impact down at the family level, you see it at the community level, you see the direct impact on people not having enough food or worrying about whether they're going to be able to cook that food, you see the economic impact, you see companies pulling out of the area, you see jobs going down, you see the concerns about security, both security at the community level as well as in the larger sense and the regional basis and you see that these factors are contributing to both a sense of isolation but it's also contributing to a sense that there's just not well-being in the countries. The fourth point that I want to highlight is related to this. We also have a combination of actions and inactions which together are making it more difficult and so what I mean by that again is very simple. The cessation of air flights to the region has simply made the region feel more isolated, it has made it materially more difficult to respond to the outbreak. You have to get things in, you have to get people in and you can't do that if you don't have the ability to fly in but on the other hand in terms of inaction, one of the key things and I think this will get highlighted in the future in the additional discussions is that the missing key piece right now is simply getting in enough people. We need more people in there, we need people with the requisite skills, we need the people in there to help provide training and so on and this is one of the major obstacles and so those things in combination are making this a particularly difficult situation. On the other hand, there are a number of positives that I want to highlight. One of them is the simple fact that people survive this disease. It is often portrayed as an unbelievably bleak situation which it is a difficult situation but people survive the disease, that's one thing. The second thing is that it is clear now that there is a very rapidly increasing level of international attention. We see that coming both from the initiatives taken by countries. I think the US announcement not so many days ago really was welcome. We see this stepping up of actions being taken by a number of countries, many of them represented in the room here and also I think that within the UN we see that same level of attention. I think right now there's a little bit of confusion about what does it mean for the UN to mount a public health mission. It has never mounted a public health mission before but in essence what this is is a collective decision within the UN and certainly at the level of heads of agencies and at the level of the secretary general to have an integrated approach to this beyond anything that has ever been done before by the UN. And so these actions are in a kind of race. We have a logarithmically increasing curve of cases. We have had a linear increase in terms of support. We're going to try to make sure that that linear increase speeds up and matches and then beats the other curve. Now in terms of things going forward, again I just wanna highlight a few things that I think are important. The most obvious one and as was mentioned by Laura is that we have to bend the curve. We have to see that decrease in curve going down and the core actions there are simply to get people out of houses so that they can't infect other people and to get them into places where they receive the right level of care and that's going to require both engaging communities and the communities themselves are really moving ahead. But it's also going to require a level of international support which is building up right now. And all of this has to culminate in the development of places for people to go to where they can be cared for. So this again requires a combination of international workers coming in and national staff working together. The second thing is that once we bend the curve we're gonna have to get rid of the tail. So we know what to do in order to break the, to bend the curve, how to break the transmission. But there are things that we don't understand right now. I mean there are a lot of health workers that have gotten infected. Why have they gotten infected? How have they gotten infected? What are the interventions that need to be done at that level to protect them? We know that there is transmission going on both in urban settings and in rural settings. Much of our experience has been at the rural level is the transmission of this disease the same in an urban setting as it is in a public setting. Do we understand, or in a rural setting, do we understand that? How do we break the transmission in cities? The third point brings us back to the main point of this meeting. How are we going to reshape culture? How are we going to build the capacities which are needed? How are we going to go forward so that we don't have to deal with this in this kind of way again? I think none of us are enjoying this very much right now. And let me again give you a couple of examples. One of the issues which ties all of the large events in the past two years in terms of infectious diseases is infection prevention and control. At a global level, we all understand it. We all accept it. We know it's important. It's at the local level where you don't see that level of implementation. This is what ties together what's going on in the Middle East with the Middle East Respiratory Syndrome Virus, MERS Virus, and what we see going on in Western Africa, which is a level of infection prevention and control, which is too low. It's too low in health settings. It's too low in communities. If you're going to have sick people moving in taxi cabs, if you're going to have people driving them in their own cars, you see that there has to be a significantly different understanding. And this is beyond intellectual understanding. It's a culture change. A second thing is that we have now clearly moved into a new era, I believe. Over the past few decades, we have seen an ascending trend in which the events that we are dealing with have become more and more complex. And at the many factors that contribute to that, at the heart of it is the issue of being more interconnected. Globalization is what makes these events more complicated. So we have globalization of information, of rumors. We have globalization of travel. We have globalization of economies and so that the cumulative impact is just bigger and more difficult and more complex than it was in the past. But right now we are in a period in which we are dealing with any number of emergencies. We see them going on in the Middle East. We see them going on in Africa. We see them in terms of infectious diseases. These are all linked events. The issues, the capacities which are needed to deal with one are also the capacities needed to deal with others. And we have now reached a level where there are so many events going on that we simply have to rethink through. And again, this is one of the important reasons for this whole discussion on global health security. It is one of the ways to address this to resolve it and is why this is such a pivotal discussion now. So finally, let me just highlight one other point. At the heart of the global health security agenda in terms of infectious diseases, but also these other events is something called the International Health Regulations. It is the fundamental agreement among the countries of the world about how they're going to address these kinds of issues. And the concept is wonderful. The framework is beautiful, but the implementation is not full yet. And that's the whole purpose of this health security agenda. There are a number of things which have to get done, but the implementation, the full implementation of the International Health Regulations, which includes the building of those capacities in places such as Sierra Leone and Liberia in Guinea is at the heart of this whole agenda. So it is not an abstract discussion. It is a very concrete discussion. Thank you. Thank you very much. It's interesting that both of you emphasized that for NGOs, they're essential to the response, the local community-based, the effort underway with respect to Ebola and Liberia, Sierra Leone, Guinea, of how do you, at a community household level, how do you break transmission? How do you isolate and protect? How do you do that? And we don't know, but we do know that the non-governmental sector is gonna be critical. The other point you make Keiji about, this is a moment in time in which the proliferation of emergencies, natural occurring, conflict-driven, pathogenic, the convergence and multitude of these emergencies stretches all of our capacities, including the non-governmental sector. And so it's not an easy transition to simply say, okay, we are going to deploy the US military into this. We're going to expand the CDC and AID engagement. We're going to put a UN operation on the ground within the region and unprecedented steps taken across the board, across this multitude of folks. It does not answer the question of how can you raise the confidence and safety of international personnel that are gonna be critical in coming in and helping staff with the trained up Liberian and Sierra Leone and Guinea and health workers and other emergency personnel. I know that this has really been a difficult factor here to raise the confidence that people will be protected, that they will have evacuation procedures and the like going forward. Laura, on that, first of all, congratulations on what's going to unfold tomorrow. It's spectacular that the highest ranks of the US leadership are coming to the table to talk about this. This is a great opportunity, it seems to me. This is a great opportunity on two fronts, multiple fronts, but on two I'd like you to comment on. One is how do we convert this moment into a longer term vision, around how the US is going to elevate health security, put a framework around that, engage with Congress and with the American people to say now's the time to push, because the pilots that were launched back in February, led by Tom Frieden and CDC around the emergency operation centers, those were very valuable at demonstrating, demonstrating what can be done with small resources and a determined collaboration between DOD and CDC and other parts of our government. We'll hear more about that today from Andrew Weber and others, but we need to bring this to scale, as you say, we need to bring this to scale with speed and with a long term vision. So that's one question. The other is we will not succeed in Congress or with the American people if we don't bring others in with us. And that means we need the EU, we need the British, we need the French. We need other partners, and the Gates Foundation has generously jumped in. The African Union is doing some very innovative things and we need a functioning and strong and resilient WHO as part of that formula. We need to recommit and refocus our efforts around the fact that we neglected this institution in these last several years. And that's part of the equation, that's a critical part of the equation. Laura, can you say a few words around how do we use this moment to greatest advantage to build the vision to the American people in Congress that we're gonna move beyond this? And how do you get others in the mix? Well, thanks, Steve. I do feel very strongly that we need to capitalize on this moment as deep and humanly upsetting. This moment is shame on us if we can't build from it. And so I really do see this as a critical moment to draw people's attention, not just to the current emergency, but to the longer term issue. And that is obviously precisely what we're trying to do tomorrow. I think when you have a chance to look at the action packages, there's two really meaningful components of them that get exactly at the points that you're making. First of all, in terms of longer term vision, they each of the 11 action packages has very specific measurable outcomes. So it allows us to say not just are we inputting the right, are we inputting, but what's the output? Are we getting to the level of what needs to be able to be accomplished on the ground? And we've tried, I mean there's lots of conversations about measurability and so on, but what we've tried to develop is indicators that say if you can do this measurable thing, then it's a pretty good indicator that all of the pieces that go into that that are less tangible and less measurable are in place and functioning. And so we've tried to find those indicators and we've done that not only internal to the US government, but through really critical conversations that we had in Helsinki and recently in Jakarta and here I really have to highlight the contributions of Finland and Indonesia to our joint leadership and that is to your other point of it's not just the US. It is a global thing and we are just so gratified at the level of global commitment that we already have. I think the 44 countries represented tomorrow prove that. When you look at the action packages, you will see that each of these action packages has leaders and contributors from around the world, over a hundred commitments made in the context of these action packages to move forward. And so I think a combination of the diversity, the breadth and the concreteness of the action packages in terms of their outcomes and their participants really is a signal that we're making, we're getting at those challenges that you've identified in terms of long-term vision. Just a word in terms of the Hill. I think it's really critical that our congressional counterparts understand the distinction between the emergency funding that we're looking for across various agencies in support of the Ebola challenge and the breakthrough funding that we've put in our 15 budget for CDC explicitly to work on global health security broadly. And the distinction, we're asking in some ways at the very practical level, the things you need to fix the Ebola problem are actually not necessarily that connected to the inputs for the long-term business. There's almost no disease that requires the level of PPE, for example, that Ebola does. So there's not really, you can't really say, well, we're fixing Ebola, and therefore we will have fixed the whole pit. And so it's important that the breadth of the long-term challenge be understood as related to, but separate from, and that we get funding not only for the emergent challenge, but also to empower the CDC and the NHHS to play their appropriate role as partners, along with DOD, State Department, ag, other parts of the US government that have been funding this mission for decades, frankly. Thank you. It was astonishing that the US was able to move so rapidly with consent of Congress on a billion dollar program of emergency assistance drawing from the contingency funding, and congratulations on that. That's not the long-term permanent fix, right? That's the ability to pivot US leadership at this moment and demonstrate and bring forward our capacities, and it opens the door to these bigger conversations. KG, you've been involved in trying to remind the world of the continuous challenges around health security, moving from SARS to swine flu through other threats, and how do you make the case? How do you make the case for a continuous, ongoing set of capacities when the threats oscillate so wildly over time so that people's sense of threat comes up and down in this period? How do we do that? Sure, so that's been I think one of, one of if not the greatest challenge in terms of developing the health security agenda and that we go through an emergency, there's a great deal of attention, there's a lot of words set about how important it is, and then it tends to evaporate during the periods in which you're not dealing with an emergency. But I think one of the differences here with the Ebola outbreak is that I think the linkage between what goes on in a health sense in terms of an outbreak and in terms of infectious diseases and its direct impact on things much broader than that. So again, the reason why this is different is that we are literally talking about the security of the region, the security implications for the world, as well as security implications for that country. We are not talking about food security, food supply as well as rising prices. If the economics in that region begin to go down, it will have a dramatic effect on the entire continent, and if the entire continent is affected, it will affect the economies around the world and so on. So we see hopefully a level of connection and so it is no longer abstract and it's no longer seen as an esoteric one-off. And so this is what we have to emphasize. I mean, this is what the discussion is going forward, have to say is that these are all linked. Thank you. We have just a few minutes left. If we could get a microphone down here if there is a roving microphone. I'd like to ask Jordan Tapperow from CDC who's just returned, he's down in the front row, from five weeks of deployment in Liberia for CDC. And I'd like to ask him to say just a few words around his reflections on this, his experiences in this critical moment. And then we're also joined by Dr. Corkor from Phoebe Hospital in Bongo, in Bone County, Liberia, who himself is a physician, but also a survivor of Ebola. I think it's very important. He will be at the White House meeting, I believe, tomorrow. Dr. Corkor, thank you so much. Jordan, thank you so much. If you'd say a few words Jordan and then hand the microphone over to Dr. Corkor. Thank you. I'll just say very few brief words. My time in Liberia was really quite impressionistic. I think when at the beginning of August you could see the need, but you really didn't see the mobilization for the kind of activities that need to bend the curve, so to speak, on Ebola. And we're really starting to see that coming together now. We now have an incident management structure that makes it possible for the country to clearly speak with one voice to its leadership about what is needed and a lot of support from WHO, CDC, USAID, and just a number of strong partners. We also see a lot of support from World Bank about trying to secure salaries for healthcare workers to join the fight that is sort of standardized so that the NGO community can come in and do a rational budgeting for helping in their assistance. There is just a remarkable need on the ground and we are starting to see with the Department of Defense and others the building of Ebola treatment units that will make it possible to get people with infection out of their homes, out of their communities and into a place where they can get care, but also turn off transmission. That is so important. But what we're going to really also need is we're gonna need the help of the international community to help do the management and staffing for the nine out of 10 healthcare providers that will be Liberians, Sierra Leoneans, and Ghanaians that will be running these facilities. And we need to have the NGO community help in the management of those facilities to make sure that the infection control practices are at the highest of standard to protect healthcare workers and to protect those who step forward to take these jobs to help take care of their countrymen and that they're able to do it safely. I think what epitomizes that last comment is the experience on the front line of the healthcare workers of these countries. And with that, I think asking Dr. Corkor to stand up and just say a few words about his experience when how Ebola came to Bonn County will be very impressionistic for you. Thank you, Jordan. CDC has really been a heroic in this period. There's 120 or 130 personnel on the ground that number is growing very rapidly. Atlanta's been turned a bit upside down. All of the A team is on its way into the region, it seems. Folks who have very important day duties are putting those aside for the time being a similar process under way at USAID in putting its best talent out into the fight. So thank you, Jordan, for all you've done. Dr. Corkor. Here, good morning to you all. Good morning. I have the honor to share my experience with you. I'm an attending physician at Phoebe Hospital, who wrote part of Liberia. My story started in an early epidemic of Ebola at a time when in my hospital, we never had about Ebola. But unfortunately, we had a patient who came from Lofa. But instead of telling us where he came from, he told us that he came from Banga. Unfortunately, we had an experience. 10 of my colleagues came down were infected, including me. We had five nurses, one physician assistants, one lab technician, and two ambulance drivers. All of them died, but I survived. Unfortunately, these healthcare workers contracted the Ebola virus simply because they didn't observe their routine protocols. And unfortunately, when they died, I had my experience, I had my experience when I was so compassionate in my profession, to the extent that I have to touch one of the nurses who died. When she died, a few days later, I became, I felt sick. When I felt sick, I decided to isolate myself from my family. After isolating myself from family, I opted for a voluntary testing of my sample. My sample was taken, I was collected and taken to Monrovia. I became positive and I was subsequently moved to Monrovia to the isolation center. While it's there, I survived because I'm a doctor and I know what I was doing. I drank a lot of water and I had confidence in myself that I was gonna make it. To the extent that when the doctor told me that you have a lot of people that have died and I was very brave and told her that if everybody could die, but I was gonna make it. So I was discharged after seven days later and I went back home. When I went back to Phoebe Hospital by then Phoebe Hospital was closed. But however, although Phoebe Hospital was closed, but we had a lot of cases where responding to complications of labor and delivery. We have a lot of caesarean sections down and we have a lot of blood transfusions down, especially for under five children. But we all is now lost. We still have hope with the construction of the ETU and we're gonna reopen our hospital. What we need, that's what Kyrgyz was saying. We need to stop the transmission of Ebola. How do we go about this? We need to train in infection control and supplies. We need to provide our supplies to be able to control or to stop transmission. Thank you. Thank you, Dr. Kofo. Thank you for being with us. It's very important to have you here in town at this particular moment. Please join me in thanking and congratulating Laura Holgate, KG Fukuda for the, where we are today in the Global Health Security Agenda, where we are in the mobilization, which is fast moving and showing greater promise for really addressing this. And thank you both for your leadership, which is so important in this moment. Peter Berger, I am the Associate Director for the Center for Science, Technology and Security Policy at the American Association for the Advancement of Science. We are very pleased to be here and part of the steering committee. And we are very thankful to Laura and Beth and Bonnie and others to involve us in this whole process. This is the start of three panels that kind of mirror the Global Health Security Agenda, the prevent, detect and respond. We have the pleasure of talking about prevention and that, as you know, can come in the form of more security. It can come in the form of safety. It can come in the form of disease surveillance and monitoring and it can come in the form of research and development, development of new technologies and so on. And with these three pillars, the health, the science and security, well for I guess, health, science, security and safety, we are going to talk about prevention of biological threats and sort of overarching the Global Health Security Agenda. So each of the panelists will come up and say a few words and then we will hopefully have at least a half an hour, if not more of interactive dialogue. We really hope that you think of good questions and can ask the questions. So our first speaker is Miss Patty Olinger. She is the Elizabeth R. Griffin Research Foundation Director of Global Programs and is the Director of the Environmental Health and Safety Office at Emory University. She is actually recently responsible for the safe reception of three Ebola patients transferred from Africa. She has practical experience with faculty and staff, not just at Emory, but also in very low resource countries, including Kenya and Nigeria as well. The second speaker is Dr. David Heyman. He is a senior lecturer in veterinary public health in molecular epidemiology and public health laboratory at Massey University in New Zealand. He made a far trip to come here. He is a conservation science, well a veterinarian as well as working in the conservation field and he spends most of his time studying infectious diseases within the human domesticated animal and wildlife populations and really trying to merge public health and conservation studies. Our third speaker is Dr. Scott Gordon. He's the Director of PATHS, Window of Opportunity Project and serves as the Senior Advisor for PATHS, Health Systems Strengthening Unit and Chair of PATHS Ebola Task Force. He develops and manages new health policy and system strengthening projects which include examining scale up of health technologies, expanding strategic approaches to health promotion and disease control programs and assessing performance of immunization and other health systems. And our fourth speaker is the Honorable Andrew Weber. He is the Principal Advisor to the Secretary of Defense, the Deputy Secretary of Defense and Undersecretary of Defense for Acquisition, Technology and Logistics for Matters Concerning Chemical, Nuclear and Biological Defense Programs. And in that sort of area, they really focus on prevention, protecting against and responding to global threats. He has had about three decades of experience working in threat reduction programs and we have asked him to really think about the role that the NGO community has played throughout his career and the contributions from his perspective that the NGO community has played. So with that, Ted. Sure. Well, hello and welcome. And thank you, Kavita and the organizing group. I really appreciate this opportunity. I'm honored to be here on this panel. I really believe that the NGO has the opportunity to be what we'll call a bridge, a bridge between funding organizations as well as a bridge between the funding organization and the recipients, either at institution or countries. This is with our building of capacity. As you've heard earlier this morning, the NGO or foundations on the ground have that ability to look at and to really get involved with what's local, practical and what we want to do is get something that's sustainable, building our capacity. So I'm gonna talk a little bit about prevent, but to me, prevent really has everything to do with also the prevent, detect and respond. Prevent is in all aspects. And to prevent, we must plan. And to plan, we must assess. To prevent, we must evaluate and what we're doing and how we're doing it. And also, to prevent, we must evaluate how we're doing it and then to be successful, we need to be able to assess our actions and our results and to then to readjust. And this is really the fundamentals of bioress management. And for those of you who know me, it would really be not a good thing if I didn't talk about bioress management just a little bit. I'm currently the co-chair of the international standard for the working group to move the bioress management standard to send workshop agreement into an ISO standard. And a positive thing, last week it was approved to go to the next step. So, for me to ask if I would talk a little bit about this and try and relate it to the current Ebola outbreak about a project that the Elizabeth R. Griffin Foundation is currently involved in. We're in phase three of a bioress production program in Kenya, led by myself and Dr. Robert Hecker. So, there was one aspect, well actually there were many aspects of this project. Today we have so many tools available to us. The tools that we didn't have just recently. And this is one of those things that for me I get really excited about. I have a lot of fun with this. We used Google, we used Skype, we used local SIM cards, email. We also used a tool that's powered by an application called I-Form Build and it was I-Form Bioress where we were able to be in country, be able to collect data, be able to send reports immediately when we did have connectivity. We could collect the data with or without connectivity. And then we were also able to provide scorecards to the institutions to be able to show them where they were at and it actually gave them reason. This is where we're at right now is working with those institutions and those facilities to be able to then work towards improving in those areas. Now one of the things I want to point out is that I'm a holistic type person even though my background is really research safety and biosafety in particular. You know, as a director of environmental health and safety who's responsible for all aspects, I can't go into a facility and say, oh no, no, no, no, we're just looking at the lab because the reality is, is that everything is associated with that lab and the whole infrastructure. And so when we walked into these facilities, one of the first things that we would do is we would go to the doctor and we would say, will you please show us your facility? We want to see what your facility is about in your whole community. And so we did. We walked through the entire facility and we saw things that they were, actually many people were just surprised that we wanted to do that. But what this slide shows you is a lot of infrastructure issues that you see. You know, water, that the whole piping system would be broken and they had to go get water for their hand washing and their drinking down into, down by the local river. Or that maybe somebody brought in a biosafety cabinet but it wasn't certified or it had broken or the little hood that they did have, which would have functioned appropriately to protect them, wasn't functioning anymore. A lot of backup lighting with kerosene lanterns, just a lot of general infrastructure that we take for granted and that they deal with on a day-to-day basis. So when you start to look at the Ebola outbreak and what we're dealing with now, I have an isolation suite at Emory. I have a whole infrastructure. I think it's been published the first two patients. We had five doctors that were dedicated there at any time. We had over 20 some nurses over 100 staff that was providing support. If I needed to have a specialist, I could call, that group could call them, whether it would be pulmonologist or whatever it would be. The infrastructure that we have there is not the same. And when we were there, we started asking questions about barrier isolation and infection control. And if they had someone who had an outbreak, what would you do? One of the facilities did have a little building that they said, you know what? If we had rift belly fever or Ebola came in, because this facility happened to be really close to the Ghana border. And they said, we have a little building that would be our isolation. This other picture was one where they said, I asked the question, the lady put her hands on my shoulder and she turned me around and she said, there's our isolation bed. And it was like, okay, you know, they had thought about it, but that was what they had thought was that, we'll just put the individuals over there in that corner. Laundry was something I don't like to do laundry to begin with. But it was one of those things where you realize very quickly that in a lot of facilities, the family comes with the patient and the family takes care of that patient while they're at the hospital or the clinic. And they actually, in this one facility, they had an area where the families could stay and they would do the laundry. And then the other was that they would bring all of the laundry to a central location where you would have a couple of people who would do laundry. But there's no communication or flow of information as far as this particular laundry came from a highly infectious patient. And so the likelihood of someone in the infrastructure or in the support structure to get infected is definitely there. One of the things that we did not anticipate but one of the physicians actually in the first facility that we were there that pointed out very quickly was that his main concern was funeral practices and morts. And the one little building up there is actually an unheated, uncooled building where they do not have the ability to embalm. The family members take the bodies and the ritual is to then prepare the body for burial. He was very, very concerned. And if you look at the infrastructure of what they have available to them to prepare bodies for burial and then the burial practices, the need to be able to touch that passing individual is definitely part of the culture and to educate that that is exactly one of the ways that people have been getting infected is important. Personal protective equipment is one of our lines of defense. And what we saw, there was a couple of things that were very frustrating to me. We saw a lack of a lot of personal protective equipment. But then when we did see it, it was interesting. In one facility, they had three individuals and someone had sent them a box, actually two boxes of goggles and face masks and some spill kits that had some Tyvek suits in them. Nobody had told them how to use them. And there were over 60 pair of goggles for those three individuals. And so there was a real, it's like somebody, we feel good when we can do something, but we need to really assess how we are doing things and then be able to, the lady in the bottom was an individual who they had one respirator in their department. And she kept that and she would reuse it when she felt that she needed to. We all know that waste practices are issues. Waste practices, when you think about it, what we have a tendency to do is go and build that half million dollar incinerator. We sometimes fail and in a couple situations, we saw this very clearly. We fail to think about how much it costs to run that incinerator. The one facility here didn't even, people didn't know how to use it. That's a, the top is a little burn area where there was actually a couple guys who would take the ash and go bury it. And it was actually very clean around it as far as taking care of the ash and everything. And then we would get to this kind of a situation where we had put in an incinerator. We had then, the incinerator broke down. There was no way to get the incinerator fixed. And so they had to go back to burn and they really didn't have the capacity. There were also two or three buildings that were completely filled with medical waste. So the Elizabeth Griffin Foundation, our whole, our project, our goals and objectives are to develop a program. And this is more of the long-term. This was actually a slide that we have produced for our long-term vision to develop a program that could be used and repeated in locations for virus management reduction, especially within low resource environments. Looking at a process that they could, that facilities could then go from, like kind of like the lead building, the silver, gold and platinum. I truly believe that NGOs are that key as far as the balance between, and can be that kind of mediator or a bridge between the donor agencies and the donor institutions and the recipients, building the capacity, being local practical and sustainable. Thank you. Sorry, I have a touch screen at home, which makes this really challenging. Thanks. So thanks very much. So this is a long-term vision. And this idea of conservation as vaccination is something that I want to stick in your heads as I go through this. So I'm a veterinarian, a veterinarian epidemiologist, but I work in lots of different systems. I've got projects now on measles in New Zealand, rabies transmission and white nose syndrome, which are fungal infection bats. So I work with a range of different infections. So human-to-human transmission, animal-to-human transmission, then animal-to-animal transmission. But what I'm gonna talk about today is, of course, the hot topic, which is about Ebola virus. And this is some work that we've been doing in West Africa for a number of years. And so Ebola virus outbreak in Guinea, five things that you should know. And one of the things that you should know is that Ebola virus has been linked to bats, and in particular, fruit bats in West Africa. And that's where a lot of my work is focused on. And Guinea, a band, bat eating, to prevent Ebola virus outbreak getting worse. But of course, the point was, it was already in the human population. But I'm gonna speak about what we might do to prevent future epidemics of infections, like Ebola virus. And this is, I just wanna put this up. This is some work Kevin Oliver and I did, which we had in review or in press, I think, as this outbreak was emerging. And this is thinking about Ebola virus transmission change. So of course, we know there's human to human transmission. We think that we know that there's bat to bat transmission. So we think that bats are the reservoirs for Ebola virus. But we think that, and we know that primates, other apes get infected, pigs get infected. Isolated Ebola Western virus from pigs in Asia, but maybe dike. We don't really know how these guys get transmitted. We don't know how this transmission path works. We don't really know if there's direct transmission or how that works. We don't understand anything about the role that dike have played. Nor do we understand the role that pigs play in transmission pathways. There may be some evidence of some issues with rodents being involved. We don't understand it as some back transmission. And we don't understand if there's any role for vectors. And that could just be mechanical transmission. So what I'm painting here, is a picture of some of the complexity about transmission pathways. But what you'll know is that there are humans, there's domestic animals, and there's wildlife. And I think we have to think more holistically about how we work in these systems and how we go about understanding the process of infection spillover from one reservoir to another. And I want to point out, so is Ebola virus an African issue? So this is Marburg virus. This is Ebola virus's cousin. The case fatality rate is just about the same as Ebola virus. So it's worse than a flick of a coin. And this, what I've done is I've mapped the distribution of the viruses as if it lives where the hosts live. So it's just like saying, measles exist where humans exist. So this looks like it's an African issue. This is Marburg virus. But this is Zaire Ebola virus. And as you can see, it came to no surprise to people like me who had redetected antibodies against Ebola virus in Ghana in 2007, 2008. So we knew that the virus was there. You can see that the bats that host Ebola virus distributed in quite a number of those species that distributed across West Africa. But you can also see that there are some species that may have this virus that also exist in Asia. There's another virus that was isolated, another cousin of Ebola virus that was isolated by chance almost from bats in Spain. So this may not be not just an African problem or an Asian problem, it might be a European issue. And then there's rest in Ebola virus. It hasn't killed humans, but it has killed people. And the distribution of the host species for that covers Europe, South Asia, and Southeast Asia. And this is what we also see. So this is in Aqqa, Ghana. This is a fruit bat that lives in the city. This is over the 37 military hospital. Lots of fruit bats over the hospital where you've got clinically unwell, perhaps immunosuppressed people. People sell their wares, all sorts. There's a fine mist of bat urine in pieces at times. So we've got increasing encroachment of bats into human space and humans into bat space. We've got increasing urbanization in places of both humans and of wildlife. And the question comes, why not kill the bats? So thinking from the conservation perspective. So this is some work published in Science about the agriculture importance of bats to US agriculture. And they're estimated that bats save the US economy more than $3.7 billion a year. Could have been as high as $53 billion a year. And that was just in pest control. And that was just for agriculture. So what about controlling pests for your forest, for example? So there's potentially a huge amount of, if you like, ecosystem services that bats provide. It's not limited to temperate regions in America. So for example, and the studies are relatively new, but this is some work in Southeast Asia where they excluded bats and birds. And they found that crop yields, particularly things like cacao, which make cocoa and chocolate, declined by 30% if you excluded bats. So they're obviously eating pests or things that can affect us of diseases for those crops. If at the end of a long day, you wanna drink of tequila, after today I can imagine you might feel the need to go and have a drink. You can't get tequila without the blue agave plant and you can't get the blue agave plant without the Mexican long nose bat, right? So bats, they do some good things. They provide services, money, tequila. But they do bad things. They can give you infections. So in many ways they're like humans. You know, they do some good things, they do some good bad things, don't get too close. And so this is where I think we have to consider there's a human health aspect and conservation aspect and there may be things that you can bring together that are beneficial for human health and beneficial for conservation. So these are both grilled and smoked bats, these are photos that I took in West Africa. In my opinion, they tasted bad as they looked, but some of my colleagues think they taste really sweet. But the point is, so this is within West Africa, but this again, it's not just a West African issue. So this is some photos of Rosetta's bats being harvested. These are piles of bats that people are sniffing through. And this is on the India-Miyama border. And these guys have been linked to filovases, like Ebola virus. And these are photos I took in Manado in Indonesia of bats being eaten in the distribution for, if you like, the rest in Ebola virus. So you're thinking, this isn't good for bats, or the slow reproducers, but it's also not good for possible spillover of serious infections. And bats are a host for a range of different infections. The point is, and this is where I think we have to think, take a step back and think even more broadly. One study has just come out, and they've estimated that there may be about 320,000 different mammalian viruses. So that's not bird flu, or flu, or bird viruses, whatever. That's just mammalian viruses, it's not bacteria. How do you prevent any or all of those becoming human infections? You can't vaccinate, you can't develop vaccines against 320,000. And of course, not all have potential to do what Ebola virus is doing, but it's very hard to predict which ones might be an issue. And that's where I think this idea of conservation is vaccination. We might be able to put in place systems that both preserve the healthy ecosystems that we're interested in, but also prevent us from being exposed to too many novel pathogens. There are frameworks already in existence that discuss this. One is the One Health Framework, and the aim is to improve, it's really to recognize that human domestic animal and ecosystem health are all interlinked. And I'll bring you back to that picture here, in that you've got a wildlife aspect you've got a domestic animal aspect and you've got a human aspect. And you have to address all of those if you want to think about prevention in a holistic sense that is both cost effective and effective for more than just a single infection. I'm gonna end with a couple of acknowledgement slides. Not to do any more than the fact that I want to highlight one thing. This slide is a list of people I've worked with on various projects over the last few years. So this list includes medical anthropologists, conservation biologists, medics, doctors, statisticians, veterinarians, ecologists, conservation biologists. And I think that's the approach that we need to be taking to really think holistically about how to prevent infection, disease, and murder. And that's also reflected in funding. My funding comes from both agencies who are interested in human health, but also domestic animal health biomedical research funders, but also conservation biology groups. Thanks. Good morning. It's a pleasure to speak to you today. And I'm going to attempt to speak to you without a PowerPoint presentation, which in this day and age is actually quite challenging. But I've been asked to give a few remarks on behalf of my organization, PATH, as well as the broader NGO community. And really thinking about how our investment in research over the past 10 years in areas such as vaccines, technologies, public health investments really has served a protective effect against biological threats. And also to talk about how our investments in the broader public health infrastructure really does help to contribute to global health security. And of course has been made very clear in a parent's morning. This is an ominous time to talk about that. It's a critical time to talk about the links between investments in research, investments in building capacity, and the threats that we all face around the world. And the Ebola crisis really serves to make the link between public health research and the threat to not only societies in West Africa, but the rest of the world very clear. Now I'm thinking about the gamut that we've talked about around research as well as public health impacts in the field. I think PATH, my organization, really serves at a unique and very valuable junction because we span the continuum from doing R&D, investigating, developing new products, new technologies, as well as working in the field to help build the capacity to be able to implement those technologies and to be able to improve the quality of the health system. We like to consider ourselves a global leader in health innovation. We work in 70 countries around the world, primarily in Africa and Asia, and we have a very strong focus on women and children's health. We have areas of expertise that really span the spectrum of public health, but we tend to focus much of our work on five main platforms, vaccines, drugs, diagnostics, devices, and really the critical underpinning of all of that, which is our support of health systems and services. And we've done so for nearly 40 years, working to really link the resources and the solutions that we see here in high resource settings with the pressing needs in low resource settings. And so one of our achievements that we're very happy with right now is the fact that last year alone, PATH-supported products technologies reached over 219 million people. And really the shining example of that is the meningitis A vaccine that we worked very closely with the World Health Organization, Serum Institute of India, as well as the critical partners throughout Africa and the meningitis belt to be able to develop that vaccine, introduce that vaccine, so that so far over 150 million people were immunized with meningitis A vaccine at a cost of 50 cents a dose. And within that belt, no reported cases of meningitis A at this point. So we're really proud about that. And I think PATH is not unique in that type of work. Many other NGO partners around the world do this type of linking service and work in the range of topics and health areas that we work on around malaria, around maternal and child health, around vaccines. So it's a critical role that we play. And I think that the role that organizations like PATH play in protecting and preventing around biological threats really are important to illustrate that critical link between the resources and solutions that we have access to here and the need around the world. And of course, the Ebola crisis right now is one of the clearest illustrations that we could look at at the link between the conditions on the ground, the lack of public health resources and infrastructure. And the importance of addressing that as a threat to health security. PATH and other NGOs are providing critical health services on the ground, as well as helping to support international efforts to respond to that crisis. As we've all seen in the news, it was MSF, Miss Anson Frontier, one of the groups that's really been at the forefront of providing treatment together with the World Health Organization, CDC, and now much broader US government, UK government investment in providing treatment on the ground. So NGOs, you can see in that regard, it's playing a critical role on the ground in terms of providing services. PATH has also been contributing to those efforts. And it's required a shift for PATH as an organization. We've not tended to be a humanitarian response agency. We've not tended to be, in many places where we work, a direct service provider. We work to develop technologies. We work to build capacity. We work to generate resources that can be used on the ground and then helping to build up that infrastructure on the ground. But we're not fielding large numbers of doctors, nurses, healthcare workers in the field. What the Ebola crisis has done for us as an organization though, has helped us to focus our own attention about how can we use the resources that we have, the technologies that we've developed, the partnerships that we have with organizations like the World Health Organization and CDC, doctors, nurses, community-based organization, how can we re-channel those resources in response to the crisis that we have right now. We are actively working to support WHO. We've seconded personnel to WHO. We're working actively with the World Health Organization around the testing of some of the promising new vaccines that are coming out. We are actively working on the ground in West Africa through our partners in the communities in Senegal and some of the other affected countries to start moving resources into the hardest hit countries, building up capacity for information management, for waste management, for communications on the field, all of which are critical roles around responding to the disease. And it's because of our links within the communities and our partnerships with the governments that we're able to provide that type of response. And that's a critical role that NGOs play in preventing these types of impacts, but also in responding to these types of impacts on the ground. I'm also pleased to say that we are working very closely with Foundation Moyu as well in Senegal. And I know that they've been one of the supporters of this event and we appreciate our collaboration with them on how can we respond within the region. So of course our work in the region as well as our work around the world in preventing these types of diseases, impacts, crises is a critical link. And one of the ways that NGOs such as PATH are able to play this link is really serving as a link between donors and technical resources and the needs on the ground. We as an organization receive support from a range of US government agencies, USAID, Centers for Disease Control, Departments of Agriculture and Defense, and the National Institutes of Health are all among the donors that provide us with the resources that we have for doing the early stage research as well as the scaleup and the testing of the technologies that we're able to put into the field. And that's a critical source of funding that we receive from the US government. We also managed to link those resources with other bilateral and government donors including the governments of UK and Canada. Together we can bring those with resources that we receive from private donors. The Gates Foundation is one of our major donors. The Rockefeller Foundation, the Conrad Hilton Foundation, as well as corporate donors and partners that we have. And that's one of the critical roles that NGOs can play in this field is being able to link those resources, bridge between the availability of resources, financial, technical and in kind with the need on the ground. Now we see that the investments in research in global health are producing tangible products that are benefiting populations around the world, particularly in the low resource settings, the vaccines that we produce, the diagnostics that we are able to degenerate, to be able to identify diseases or viruses such as Ebola quicker, play a critical role in being able to respond to these. And it's also the infrastructure that we are able to develop on the ground is something that serves as a bulwark against these types of crises. In order to translate the development of technologies, the investments in R&D into the field, it takes going down and working with local laboratories, with local physicians, with local laboratories to be able to build their capacity. And so in that regards, we see that NGOs such as Path playing a critical role in linking down to the infrastructure on the ground. So I'm very pleased to be able to speak with you this morning. We're very excited about the role that the GHSA can play in maximizing the US government as well as the global impact on research and development and the translation of that into address the needs on the ground. And we're also very excited about the role that it can play in trying to maximize the impact of those investments by coordinating, by thinking through the lines of investment in research and development, such that we're not looking at each individual agency with their own individual agenda for what they're going to support, but really a much more coordinated response towards addressing the pressing public health needs around the world. Moving away from each agency, setting their own individual priorities to a coordinated response to address pressing issues and crises around the world. And with that investment, we see that it is possible to move from the early stage development of new products and technologies down into actually being able to respond to the needs on the ground. So we're very excited about the discussions today. I'm very sorry, and our heart goes out to all of the colleagues in the global health space, particularly our colleagues in West Africa who are particularly hard hit by the Ebola crisis. We have committed our organizational resources, our individual resources to do what we can to help respond to that. And so that provides a very solemn framing for today's discussion, but we feel it's a very important discussion and we're very happy to join with the discussion, looking to see how we can redouble our efforts to not only respond to pressing health issues like the current Ebola crisis, but also look beyond that. Take the 30,000 foot view to see how we can better coordinate our resources in advance to prevent these types of outbreaks in the future by building up the capacity of the infrastructure on the ground. So I very much appreciate this dialogue and I'm very happy to be with you today. Thanks very much. Good morning, everybody. DoD invented PowerPoint, so I'm not gonna use it. First, I wanna just thank our hosts here at GW and Kavita AAAS. It's really humbling to be on a panel like this and to be with so many real experts and leaders, especially from the NGO community that I've worked with over the years. So thank you for the passion that you bring to this. And really you are, you know, Laura and I and Beth sort of and Bonnie, we're in the day-to-day government fight, but you are the brains of this operation and you are the muscle too. You're out there at the pointy end of the spear in this really global effort to stamp out epidemics. And so thank you for what you do and especially for your dedication and passion to this noble cause. You also bring agility, which is something we don't always have in the government. And I wanna shout out to Scott Dall and the Gates Foundation for stepping up to help out with the Ebola crisis with a starting pledge of $50 million worth of contribution. So that's a big deal. And I just have to, I can't resist. I have to give a special shout out to one of my superheroes, the superhero of the Global Health Security Agenda, Beth Cameron. Beth, can you just stand back? Okay, well, I'm gonna actually talk about something that is part of the Global Health Security Agenda, but people don't like to talk about. So I'll take this opportunity and that's biosecurity because I think it's a really important part of the prevent piece of this, what has to be a global effort. We look back at case studies of bioterrorist attacks and efforts, going back to 1995 and the Aum Shinrikyo anthrax program, not the sarin gas program that we know about, but their anthrax program that we learned about from interviews with prisoners on death row from that apocalyptic cult. We went into Afghanistan in the fall of 2001 and discovered that Al Qaeda had an anthrax facility in Kandahar. Most recently, Al Qaeda in the Arabian Peninsula put out a call to brothers with degrees in chemistry and microbiology to develop weapons of mass destruction. So these, this network of death, they have the intent and have tried to obtain biological weapons capabilities and we've seen them fail in their efforts to obtain virulent starter culture of the Silasanthracis. So that tells me that we have an opportunity to prevent bioterrorism attacks by looking at the supply side, by doing a better job consolidating dangerous pathogen collections to a minimal number that's needed. And I was really pleased that the director of CDC, Tom Frieden, after some of our own wake up calls here in the United States called publicly that we must minimize to the absolute minimum number necessary select agent laboratories and people who work on these select agents. And that's new coming from the public health side of this. We've been noting this from the security side for a long time, but that minimization, consolidation into just those fewer, safer, more secure laboratories, that is something that we need to implement over the next five years of the Global Health Security Agenda as an important part of the work plan. Our own experience with bioterrorism here in the United States in the fall of 2001, that was a defense insider, Bruce Ivins, who, because he was an insider, he had access to the starter culture, to the decilicent races. And he did everything from weaponization to delivery by himself. And so this is a potentially a strategic weapon in the hands of terrorist groups or even individuals. And we all have a responsibility and an obligation to prevent terrorists from getting access to dangerous pathogens that they need to develop weapons. I also want to just say about containment laboratories. We need to start with the premise of doing no harm. When we had the avian influenza outbreak in Southeast Asia, the World Bank and others were willy-nilly going around building BSL3 laboratories. And the World Bank now looking back, they realized that was a mistake, they're expensive, they're difficult to operate, and they're not needed for diagnostics. The technology revolution in diagnostics is moving away from big fixed laboratories to point-of-care diagnostics. And culture-independent diagnostics are better, faster. And if we link those to information technology, we can have that real-time global biosurveillance capability that the world needs to prevent the next Ebola crisis. So I think and PATH can play a very important role in facilitating the transfer of molecular diagnostics and other new technologies that don't require culturing of bacteria and virus, which is slow and dangerous. For example, the Department of Defense is delivering today two laboratories to Liberia, one to Monrovia and a second to your home in Bonn that will have molecular diagnostic capabilities operated by our Navy microbiologist and virologist. I mean, I've heard some of our defense contractors offering to send mobile BSL4 laboratories to Liberia to help with the Ebola crisis. That's nuts. That's not what they need. They need rapid culture-independent diagnostics. And finally, I wanna talk about a pillar of the Global Health Security Agenda, which is national and regional biosecurity systems. So much of what's done around the world is individual facility-based, and that's not good enough. Recently in the United States, we have certified laboratories for certain select agents, but then it's not acceptable that a country like the United States can find in a laboratory that's not certified that back in one of their old freezers sitting for decades, very olivirus. So we need a better system here, but most countries don't even have sort of a national select agent program. The best example I've seen around the world is the Danish Center for Biosecurity and Biopreparedness. Where's Nina? There you are. That is a great model, and we all have a lot to learn from how you do biosecurity in your country. And thank you for sharing that knowledge as part of this Global Health Security Agenda with partners around the world. So this national approach is very important. And sample transport can also help reduce the number of laboratories, containment laboratories that are required. So I'm just gonna conclude by reading from the Global Health Security Agenda, Biosecurity and Biosecurity Action Package, the five year national target. And I would ask all of you to think about how we can help implement this efficiently and effectively. And I'll just read the first part. It says, a whole of government national biosafety and biosecurity system is in place, ensuring that especially dangerous pathogens are identified, held, secured, and monitored in a minimal number of facilities according to best practices. We can make that happen, and with your help we will. So thank you very much. Thank you very much. So what we've heard were three examples of different NGOs that are making a contribution both on the prevention and in some cases in the response side, and a way of thinking about prevention not only from the health, but also from the security. So I invite you to ask questions. We have roving mics, so please raise your hands. As you guys are thinking of questions, let me just ask one quickly, which is, in many parts of the world, we sort of don't necessarily know exactly who we can work with and how we can trust them. And so how, as an NGO community, can we really sort of encourage positive partnerships, positive relationships with other NGOs throughout the world to be able to meet some of these needs, whether it's on the health, safety, or security sides? Anyone? Who's that for? Anyone? Buying time for people to get up and ask questions. Okay, is it working? Yeah. Okay, it's working. You know, that's a really good question. One of the things that I've found over the years is the networking and connecting. And it's not necessarily within our own little silo, it could be within other areas that you find that somebody is working maybe in a water or water reduction or an environmental area for my discipline. And when you find those connections and networks, you find also advocates to be able to maybe help you if you're going into those areas. And I don't think that we can say enough about that. And here today, we have the opportunity to meet each other and there are things that we all have skillsets and abilities to do. And I think that's one of the things that it's not, we have to get over the fact that we're not really competing, that we are here to work together. And I think that that's critical. Yeah, just to respond to that question, I think it's an interesting one. And I'm pleased there are so many government officials here. I think it's interesting that as, if you look from the government perspective, you have your government's agenda. And one of the issues in working in many countries is that those agendas may not match what the people in those countries actually want or need. And it's interesting when you're talking, everything from laboratory capacity to surveillance to all these things that we'll hear about is that actually you need to engage with what the local people who are on the ground want and need and not what you think they want and need or what you want to do. And just to give some brief examples from the infectious disease world, if I think about surveillance and diagnostic of things like Ebola virus or Nipah virus or some of these other novel viruses and bats. You know, you can set up a laboratory that goes and then you can ask them, or Avian influenza is a classic example. There'll be a laboratory in a country and every year they will open up the laboratory and they'll do the diagnostic tests that they've been asked to do by an agency. And then they'll close the laboratory door and they'll walk away. What is much better is if the, or I believe what would be much better is if you discuss with those people, you find out that actually the thing that is killing all their backyard birds is Newcastle disease virus. And it kills 40, 50% of backyard chickens a year. And actually if you had them up and running doing with facilities that enable them to do routine diagnostics on those, they could then notice when their tests for Newcastle disease virus, for example, wasn't positive, but something still killing the chickens. And then it comes away from being a single one week surveillance study to an annual study. But it involves asking those local people what they want and what their issues are. And I think that's where the NGOs can be really good because you don't have to come in with your own set agenda because you're worried about your own government security. Could I add to that? That is such a good example. We can't have diagnostics that only check for these very rare diseases. They need to be routine. And that's where technology also is helping us. We can have panels of 100. It's actually going to be limitless the way technology is driving in this area. But multiplex systems that are FDA approved so they can be used for public health as well as clinical use with rapid results so you don't have to send it out to a laboratory and wait a week that the clinicians can actually do their jobs better. But it needs to include routine diseases, seasonal flu and not just the zebras. Yeah. And if I could just add one final point I agree with everything that my fellow colleagues and fellow panelists have said. And I think the need to align with the local collaborators really extends from both the design and development and targeting of what interventions what technologies down to how things are implemented. And so really working with the networks of partners. And I think that's one thing that the NGO community brings is that much of what we are able to achieve the vast majority of what we're able to achieve is really due to our local partnerships on the ground with community-based organizations with local organizations. And so I think working through the international as well as local NGO channels provides you with that access down to the local needs. Yeah, I think that a couple of us had talked about the NGO is that bridge, the bridge between the donor community and the local needs on the ground. And I think one of the words on my slides was sometimes it's almost a mediator where we're mediating those needs. If I'm doing a project for Andy I need to be cognizant of what he wants as objectives but I also have to be very, very concerned about what they need on the ground. Any other question? Yeah. Thank you very much for inviting India for this meet. And my question is to Dr. David Heman. So it was a very good presentation. And I must tell David that I was a student also during Massey University alumni for doing one health hub and biosecurity MPH. The question is regarding that you have shown something on Asia that Ebola virus is present. So it was not really clear that is it in India and other Asian countries are having Ebola virus or they have a threat to have Ebola because of the presence of bats in it? So there have been antibodies detected against Ebola virus from bats in Bangladesh, I believe. And those species exist in India and a Western Ebola virus has its origins in the Philippines. Though, again, the species that the antibody results show those species don't just exist in the Philippines. So it won't, at the minute, we're not too sure if it's Zaire Ebola virus, the same one that is causing the outbreak in West Africa but certainly there are feeler viruses in bats in Asia. Yes. And we don't know specifically because the problem is it's really hard to actually capture the time when bats are infected. It's much easier to find antibodies so which show historical infection and those are usually nonspecific. They can't tell exactly which one, which of those bats have seen in their history. But yeah. So I do want to sort of... What are any studies carried on in the laboratory in Bangladesh? I only, not that I know of feeler viruses. There have been for Hinnipa viruses, so there's a Nipa belt in Bangladesh where people get Nipa, which is a fatal and capitalitis from bats. But I think there's only one study that's come out of India for that. I think it's quite difficult to get some of those samples out to be tested. But does the issue supply it for India? Yeah, I realize that. It stops at the border. Yeah, David Brighton with Results. Really fascinating panel and I just wanted to ask, there is an infectious disease circulating spread by coughing. It's killing 3,000 people a day actually. More than Ebola, more than malaria, more than MRSA, it's tuberculosis. And I wonder if you might address that. I'm wondering if there may be scope for Department of Defense investment in fast diagnostics for that. There are things we can do to prevent TB by treating the latent infection, but we're not serious about that. We have the President, Obama, proposing a massive cut to USAID's TB program every year now. So it's something that countries, we're not really taking that seriously. We have a real serious healthcare going on in El Paso right now, 750 infants exposed to TB that's making the news. So I didn't know if there might be scope for greater federal engagement on that issue. I guess as the Fed on the panel, I'm supposed to answer that. The, obviously TB is, especially MDR and XDR TB are very important challenges. There are a lot of vertical programs and this is one of the problems the WHO, Margaret Shan has noted that most of the funding goes to vertical single disease programs and not to system strengthening to what we now call global health security agenda capabilities, IHR core capacities. And I think certainly on the diagnostic side, there's room to include TB in that. But historically, the TB has and continues to get a lot of resources. But I'll go back to my little sliver that I'm focused on today. I visited a TB lab in East Africa. And they were sending samples, testing for antibiotic resistance and the samples go to the lab and it would take about six weeks to get the results and the clinicians would never get the results. So, and this was a biosafety level three laboratory. So we need better faster. And there are some, but they're still a little bit pricey. Rapid diagnostics, molecular diagnostics for TB. So we can do it better and faster. And make it useful to the clinicians. Justin Keita with the FBI. For Mr. Weber, you referenced bioterrorism in your remarks and I was curious with the reports in the media from a few weeks ago, the individuals that ransacked and stole the bedding and the samples and whatnot. Has that led to any sort of increased engagement overseas between the public health sector and maybe the law enforcement and the military and whatnot in that extra vector of contamination with this particular Ebola virus? Well, I don't have information to speak to that particular event, but I will say the intent of the global health security agenda is to get these different sectors. Health sector, law enforcement sector, in some cases the defense sector. Tomorrow we're gathering with the home affairs ministers with health ministers, national security advisors, and it really does require that whole of government approach. It's not just the WHO and the organization for international episodics that will be on hand tomorrow, Interpol will also be there. So these are multi-dimensional challenges that require that whole of government approach. I'm very proud of what the Republic of Korea has been doing in this area. And I visited in August with senior members from your agency and from CDC, from HHS, DHS, FEMA, and we worked across the table together with Australia with 18 different agencies of the Republic of Korea that have to be involved, including their Korean CDC, which traditionally wasn't even known to their security and law enforcement community, on a bioterrorism tabletop exercise series called Able Response. And this was the fourth one and we've made a lot of progress. Now they know each other. The first year we did this, they were exchanging business cards that morning. But we learned the hard way in our country with the Amerithrax attacks, especially after 9-11, that these challenges require strong interagency participation, planning, exercising preparedness. And that's the model that the Global Health Security Agenda intends to reinforce. Thank you. I'm from Malaysia. I have a question on the laboratory instruments. Given that a lot of people coming in nowadays are unknown on unsuspected cases like Ebola and we send the blood samples to the laboratory, chances are we don't inactivate the blood before we proceed to the laboratory investigations. So what are the risks of instruments or equipment such as centrifuges or biochemical analyzers spreading the disease within the laboratory? Well, I can just comment. Just in terms of the virus, the virus itself is not particularly stable outside of the mammal host. So in the practice, if it depends on the laboratory practices, but you should be able to do routine laboratory hygiene practices, if you like, to keep things clear. I mean, it's not a stable virus. So centrifuges, I mean, I wouldn't have thought that it'd be a route for transmission. But I mean, obviously if something, there's a theoretical risk that could happen and it may happen, but I think probability is very low. But yeah, there's lots of variables, but it's not a very stable virus outside of the mammal host. Patty, could you maybe talk a little bit about the risk of sort of, or ways in which one could prevent infection? For equipment? From the laboratory sampling? So I mean, that's a concern. I mean, we're getting a lot of questions with regard to sample handling and preparation because there's obviously a lot of sample handling that happens just on a routine, not testing for Ebola, but just routine blood workup and everything. So we actually have set up a dedicated lab just outside and I don't have a slide with actually the setup of it, but we have an area within the hospital that's dedicated to this. So it's just for the Ebola patients and the support. And we have a laboratory right there where we have it set up so that they can do the testing. And we also now, we just purchased the PCR so we can do rapid testing. And we do fill out the category A, you know, the farms. Just in case anybody has any questions. And because we're not a select agent site. So what we did is we worked with the laboratory personnel to make sure that their personal protective equipment, we did the risk assessment. And that's been very interesting to do the risk assessment with this agent because we don't have a level four lab. And this is not what you would consider a level, a three lab. So we're using a biostatic level two area with enhanced personal protective equipment and work practices. So that's what I guess I would reiterate is the basic principles of virus management where you look at, you know, what it is that you're working with and do that risk assessment and then be very, very strict on your procedures and how you're handling it and disposing of it. Which as you've known in the press here recently, disposal issues associated, what we're dealing with here in the United States is a real issue. I could just add though, in addition to the procedures that you're going through with the lab and this is something that Andrew mentioned in his presentation, what are the critical challenges in responding to a situation like this though is the links between where is the patient or the potential case found and when is the actual diagnosis of Ebola happening? What are the time delays between that? What are the steps that it has to go through in order to get there? Clearly the situation in Liberia, Sierra Leone are catastrophic and we see that response is coming in right now and there are efforts to get more laboratory resources into those countries to respond to the crisis right now. Part of the fear that we in the broader NGO community have is around the surrounding countries. What are the delays that it's going to take when you have a suspected case out in the village in one of the other countries that's not scaled up to that level? What are the delays that it's going to take in terms of getting that sample, getting the sample to the lab, which is probably if anything is in the capital city that may not even be in the country, you have to send it out of the country to get it tested. What's happening with the patient while this is going on? What is the feedback back to the actual point of identification of that suspected case? So there and then what is the capacity to be able to actually respond along the way? So I think there are the challenges directly within the lab around the transmission of the, and the concerns around the transmission of the virus at that point, but there are many links in the chain up until that point and then back down to the patient that are critical to respond to from a planning, a preparation and a response capability to make sure that this does not continue to spread throughout the region beyond the countries that are already hit right now. And those are also things that we need to be thinking about in terms of where do we have the diagnostic capabilities? Are we getting the capabilities to diagnose much closer to the point of the actual identification of the suspect case? Or do we have the information flow back down to that level so that once we know we have a confirmed case, we can take appropriate responses in terms of really quarantining that case and making sure that there's adequate response. So there's numerous links in the chain that we need to also be addressing in addition to, and not in set, but in addition to just the basic biosafety standards in the lab. And I just wanna follow and bring that back to your original question about that. So you were running a routine laboratory during diagnostics for a range of different things. So there was a really nice study, or it's not nice actually, but it was an interesting study done in Malawi looking at cases of cerebral malaria in children. And it was all about misdiagnosis. And one of the issues is that these children had severe malaria. They did a study where they ruled out bacterial, sorry, they had encephalitis. So they ruled out bacterial causes, which they could diagnose from spinal taps. They then looked at those cases and said, how many of those are caused by malaria? And on the blood smears, all of them were malaria positive. So they had all been diagnosed as cerebral malaria, but actually, I think about a hundred of kids, from that study, a large proportion of them didn't have cerebral malaria. They had malaria, but they had something else that was causing the brain infection. And then about 10% of those, it was actually rabies, it was undiagnosed rabies. But there was a great big watch of them, which was 50, 60%, which they just don't know what caused the encephalitis. And that's true of chem-encephalitis even in developed countries. So I think just broadly, when you're thinking about diagnostics, you have to do best practices because we don't know what is killing people in a large proportion of the world. So I think just in general, there has to be best practices and you can never make assumptions about anything. So even if you don't have a BSL3 or BSL4, but you have to always imagine these other things. So I mean, one of the key things I think that you've heard here is that you see four different groups where when they work really closely together, you actually are really supporting the global health security agenda. You know, our doctor here, our special guest indicated, the training and the need. The training and the need actually supports the building to be able to immediately identify that there is an issue and then the key element of communication up to a ministry of health or to their defense supports not only the biosecurity or the security aspects of our health, but also for the prevention of a terrorist attack or something of that nature. The key links of this is that we're building that safety net, that safety net, which then enables us to be able to look at the not only diagnostic testing, the biosecurity, but the health and wellness of the community that is there and that is working in this area on a day-to-day basis. Thank you very much. This is the conclusion of this panel and some of the things that I hope you take home with it are the developing of relationships between all sorts of different communities and organizations, individuals prior. The need for system strengthening and communication, the role that science, health, safety and security all play and the links and the partnerships between the NGO community and various other, not just health, but also the security agencies as well. So thank you very much. We have a 15 minute break followed by the detect panel. So please be back here at 1030.